Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network

Abstract

Objective To describe the characteristics of children seeking emergency care for firearm injuries within the PECARN network, and assess the influence of both individual and neighborhood factors on firearm-related injury risk. Methods This was a retrospective, multicenter cross-sectional analysis of children (<19-years-old) presenting to 16 pediatric EDs (2004–2008). ICD-9-CM E-codes were used to identify and categorize firearm injuries by mechanism/intent. Neighborhood variables were derived from home address data. Multivariable analysis examined the influence of individual and neighborhood factors on firearm-related injuries as compared to non-firearm ED visits. Injury recidivism was assessed. Results 1,758 pediatric ED visits for firearm-related injuries were analyzed. Assault (51.4%, n=904) and unintentional injury (33.2%, n=584) were the most common injury mechanisms. Among children with firearm injuries, 68.3% were older adolescents (15–19 years-old), 82.3% male, 68.2% African-American, and 76.3% received public insurance/were uninsured. Extremity injuries were most common (75.9%), with 20% sustaining injuries to multiple body regions, 48.1% requiring admission, and 1% ED mortality. Multivariable analysis identified firearm injury risk factors, including adolescent age (p<0.001), male gender (p<0.001), non-Caucasian race/ethnicity (p<0.001), public payer/uninsured status (p<0.001), and higher levels of neighborhood disadvantage (p<0.001). Among children with firearm injuries, 12-month ED recidivism for any reason was 22.4%, with <1% returning for another firearm injury. Conclusion Among children receiving ED treatment within the PECARN network, there are distinct demographic and neighborhood factors associated with firearm injuries. Among younger children (<10 years old), unintentional injuries predominate, while assault-type injuries were most common among older adolescents. Overall, among this PECARN patient population, male adolescents living in neighborhoods characterized by high-levels of concentrated disadvantage had an elevated risk for firearm injury. Public health efforts should focus on developing and implementing initiatives addressing risk factors at both the individual and community level, including ED-based interventions to reduce the risk for firearm injuries among high-risk pediatric populations.

Long‐term Mortality in Pediatric Firearm Assault Survivors: A Multicenter, Retrospective, Comparative Cohort Study

“…Adolescent age, male sex, black race/ethnicity, and public insurance status were independent risk factors for mortality after surviving trauma. Importantly, these variables were also those that were associated with being a victim of assault in our sample, mirroring those described in prior studies . On the other hand, our study did not detect additional independent risk posed separately by exposure to FA or NFA nor a dose‐dependent association with mortality risk by assault‐exposed cohort.…”

“…American children account for more than 90% of all children killed by firearms in high‐income countries . Pediatric and youth survivors of firearm injury and other forms of assault are at particularly high risk of trauma recidivism . Recent evidence suggests that both firearm injury and nonfirearm assault (NFA) patients presenting to an urban emergency department (ED) have higher risk of 5‐year mortality in comparison to those who present after motor vehicle collision, and those victimized by firearms have a particularly high risk of death in the first year after their index injury, largely due to homicide by firearm .…”

“…Prior research on pediatric firearm‐related injuries has focused on the clinical features and demographics of children cared for in the clinical setting, highlighting that these children tend to be adolescent males and socioeconomically disadvantaged and from racial and ethnic minority groups . These factors have also been associated with risk of subsequent firearm injury among pediatric survivors of both assault and firearm injury .…”

“…In one urban pediatric cohort, the trauma recidivism rate among penetrating trauma patients was about twice that of blunt trauma patients . While the body of literature underscores the disparate health impacts of violence in America, such studies are limited by follow‐up periods that were brief or did not extend beyond adolescence . No studies have examined long‐term mortality among pediatric survivors of firearm violence nor compared these outcomes to those who survive other forms of assault and trauma.…”

Living in “Cold Spot” Communities Is Associated with Poor Health and Health Quality

“…21 Neighborhood deprivation has been tied to an individual's risk for child abuse, low birth weight, adolescent pregnancy, childhood injury, and firearm injury. [22][23][24] From an economic perspective, Chetty et al 25 found that childhood neighborhood poverty can have long-lasting detrimental effects on an individual's adult income. Less has been published on the relationship between neighborhood deprivation and the quality of care delivered.…”